Individual
THEODORE E YAEGER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 713-6622
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 713-6622
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
2006-00936
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906556
—
NC
Enumeration date
04/10/2006
Last updated
11/17/2010
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